Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | D50546 | MD |
NPI | 1831117472 |
---|---|
Provider Name | Dr. Joan L Blomquist |
First Address | Boston, MA 02241-8953 |
Second Address | Baltimore, MD 21204-6831 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 14/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
091700100 | (05) | MD |
F92435 | (02) |